Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
Other names
Mary Black Gastroenterology Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Authorized official
DEBBIE BREWER (DIRECTOR PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
11 DOCTORS PARK DR, SUITE 240, SPARTANBURG, SC 29307-1024
(864) 573-3593
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8080
(864) 582-5188
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
12/11/2008
Last updated
01/08/2009
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